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Aim To establish the added effect of a chemotherapeutic cooling solution in an ultrasonic device on clinical parameters of periodontal inflammation following non-surgical periodontal therapy. Methods The MEDLINE-PubMed, Cochrane- CENTRAL, and the EMBASE databases were searched. Probing pocket depth ( PPD) and clinical attachment level ( CAL) and their changes were selected as outcome variables. Subgroup analyses were performed according to the following active ingredients: essential oils ( EO), povidone-iodine ( PVP), and chlorhexidine ( CHX). Results Screening of 100 unique papers resulted in 14 eligible publications, including 16 comparisons. The meta-analysis ( MA) showed that when the ultrasonic cooling solution had adjuvant chemotherapeutic properties, the difference of means (DiffM) for end value PPD-0.12 (95% CI: −0.42; 0.18) and for CAL the DiffM+-0.13 (95% CI: −0.39; 0.14). None of these were statistically significant, and the findings were supported by the overall descriptive analysis. Subgroup analysis only revealed a small effect for PVP on the difference (DiffM = −0.23, 95% CI: −0.43; −0.02) with respect to CAL ( p = 0.03). Conclusions The collective evidence indicates that overall, no additional effects were observed. There is a 'very weak' recommendation based on the sub-analysis showing that in conjunction with PVP, a very small gain in CAL may be expected. For the use of CHX or EO, the added effect can be considered to be 'zero.' Therefore, the strength and direction of the recommendation emerging from this review is against their use. [ABSTRACT FROM AUTHOR]

Aim The aim of this systematic review was to evaluate the efficacy of anti-plaque chemical formulations for managing gingivitis, in 6-month, home-use, randomised clinical trials ( RCTs). Material and Methods A protocol was designed, including inclusion and exclusion criteria to identify RCTs assessing gingival and/or bleeding indices. Electronic and hand-searches identified relevant papers, which were screened and evaluated for inclusion. Full-papers were retrieved and relevant information was extracted (also plaque indices), including quality and risk of bias. Mean treatment effects were calculated to obtain weighted mean differences ( WMD) and 95% confidence intervals. Results After the process of screening and selection, 87 articles with 133 comparisons, were included in the review. The additional effects of the tested products were statistically significant in terms of Löe & Silness gingival index (46 comparisons, WMD −0.217), modified gingival index ( n = 23, −0.415), gingivitis severity index ( n = 26, −14.939%) or bleeding index ( n = 23, −7.626%), with significant heterogeneity. For plaque, additional effects were found for Turesky (66 studies, WMD −0.475), Silness & Löe ( n = 26, −0.109), and plaque severity ( n = 12, −23.4%) indices, with significant heterogeneity. Conclusion Within the limitations of the present study, formulations with specific agents for chemical plaque control provide statistically significant improvements in terms of gingival, bleeding and plaque indices. [ABSTRACT FROM AUTHOR]

Objective: To assess methods, quality and outcomes of systematic reviews (SRs) conducted to evaluate the effectiveness of root coverage (RC) procedures in the treatment of recession-type defects (RTD). Methods: MEDLINE and EMBASE were searched up to and including April 2010 to identify SRs investigating the effectiveness/efficacy of surgical interventions for the treatment of patients with RTD. Searching was conducted independently by two reviewers, and data extraction was based on the methodological criteria applied and on the effects of interventions reported by each SR. The checklist proposed by Glenny and colleagues, the Overview Quality Assessment Questionnaire and the "Assessment of Multiple systematic Reviews", instrument were used to assess the quality of SRs. Additionally, the methodological criteria applied by included reviews were compared with those proposed by the Cochrane Collaboration. Results: Search strategy identified 716 potentially eligible articles, of which 12 papers regarding 10 SRs were included in the study. Results from different SRs showed that subepithelial connective tissue grafts associated or not to coronally advanced flaps can be used to reduce recession depth and improve the width of keratinized tissue. All quality assessment tools showed that most of the SRs were of good methodological quality, but they also highlighted key points that could be improved in future reviews. Only two SRs followed in full the guidelines proposed by the Cochrane Collaboration. Conclusions: All SRs agree that RC may be anticipated by different surgical procedures. However, differences in the methodological quality between reviews were quite evident, and thus making a clear indication that there is a need of standardization of the methods that will be applied by future SRs. As a result, a standardized checklist for reporting SRs was proposed by the authors. [ABSTRACT FROM AUTHOR]

Aim To report the evidence on the effect of mechanical and/or chemical plaque control in the simultaneous management of gingivitis and caries. Material and Methods A protocol was designed to identify randomized ( RCTs) and controlled ( CCTs) clinical trials, cohort studies and prospective case series ( PCS), with at least 6 months of follow-up, reporting on plaque, gingivitis and caries. Relevant information was extracted from full papers, including quality and risk of bias. Meta-analyses were performed whenever possible. Results After the screening of 1,373 titles, 15 RCTs, 10 CCTs and 2 PCS were included. Low to moderate evidence support that combined professional and self-performed mechanical plaque control significantly reduces standardized plaque index [ n = 4; weighted mean difference ( WMD) = 1.294; 95% CI (0.445; 2.144); p = 0.003] and gingivitis scores [ n = 4; WMD = 1.728; 95% CI (0.631; 2.825); p = 0.002]. The addition of fluoride to mechanical plaque control is relevant for caries management [ n = 5; WMD = 1.159; 95% CI (0.145; 2.172); p = 0.025] while chlorhexidine rinses are relevant for gingivitis. Conclusion Mechanical plaque control procedures are effective in reducing plaque and gingivitis. The addition of fluoride to mechanical plaque control is significant for caries management. Chlorhexidine rinse has a positive effect on gingivitis and inconclusive role in caries. [ABSTRACT FROM AUTHOR]

Aim The aim of this systematic review and network meta-analysis (NMA) was to compare the efficacy of different anti-plaque chemical agents, in 6-month, home-use, randomized clinical trials (RCTs), in terms of plaque index (PlI) changes. Material and Methods RCTs assessing PlI were identified, screened, and evaluated for inclusion. Relevant information was extracted, and quality and risk of bias were assessed. Mean differences between baseline-end were calculated to obtain weighted mean differences and 95% confidence intervals. NMA protocols were applied to assess direct and indirect comparisons among products using Turesky PlI. Results Eighty-three papers were included: 49 examined dentifrices, 32 mouthrinses and 2 both. The NMA analysed 51 studies including data from 4242 and 4180 subjects for dentifrices and mouthrinses respectively. For dentifrices, triclosan-copolymer and chlorhexidine showed the greatest effect, with significant differences when compared with stannous fluoride. For mouthrinses, essential oils and chlorhexidine showed the greatest effect, with significant differences when compared with delmopinol, alexidine and cetylpyridinium chloride. Conclusion Within the limitations of this study (including the severe imbalance in the amount of evidence), dentifrices containing triclosan-copolymer or chlorhexidine and mouthrinses containing essential oils or chlorhexidine showed the greatest effect on PlI scores as assessed with NMA. [ABSTRACT FROM AUTHOR]

Aims To compare gingival crevicular fluid ( GCF) cytokines/chemokines levels between periodontally healthy subjects and subjects diagnosed with chronic periodontitis ( Ch P), before and after non-surgical periodontal treatment, and to establish their predictive value for periodontal disease progression. Methods Studies indexed in MEDLINE and EMBASE published in English, Portuguese and Spanish were eligible for this review. Database searches up to December 2015, and manual search of the reference list from reviews and selected articles was performed. Only studies providing data on GCF cytokines/chemokines levels in subjects diagnosed with Ch P and periodontally healthy controls were included. Cross-sectional, case series, single-arm clinical studies, randomized controlled trials and prospective/retrospective cohort studies were included. Meta-analyses were conducted for those cytokines/chemokines with at least three available studies. Results GCF levels of IL-1 β, IL-6, IFN- γ and MCP-1/ CCL2 were significantly higher in subjects diagnosed with Ch P than periodontally healthy subjects. A significant decrease in GCF levels of IL-1 β and IL-17 was observed after non-surgical periodontal treatment, whereas a significant increase was observed for IL-4. Conclusion Evidence for significant differences between periodontal health and Ch P was observed for a few cytokines and one chemokine. No conclusions could be drawn with regards to increased risk of disease progression. [ABSTRACT FROM AUTHOR]

Aim The aim of this retrospective analysis was to assess healing of intrabony defects treated with minimally invasive non-surgical therapy ( MINST). Methods A retrospective analysis was carried out in 35 consecutive intrabony defects treated by MINST (without any adjuncts) in 23 non-smoking patients. All defects had a radiographic intrabony component > 3 mm and had clinical and radiographic data available at baseline and 12 after treatment. Pre- and post-treatment radiographs were analysed and bone levels were compared by multilevel linear regression adjusted by latent variable method. Results Following MINST, the average PPD and CAL reduction in the intra-bony defects were 3.12 mm and 2.78 mm respectively ( p < 0.001). The average radiographic intrabony vertical defect depth was reduced by 2.93 mm (from 6.74 mm to 3.81 mm) ( p < 0.001), whereas the average defect angle changed from and 28.5° at baseline to 44.4° at re-evaluation ( p < 0.001). Smaller initial defect angles and deeper initial defect depths were associated with greater defect depth reduction. Greater initial defect angles were associated with less defect angle change. Conclusions This paper shows considerable clinical and radiographic improvements after MINST, therefore bringing evidence to support its efficacy for the treatment of intrabony defects in non-smokers. [ABSTRACT FROM AUTHOR]

Aims To update the existing scientific evidence on the efficacy of local antimicrobials as adjuncts to subgingival debridement in the treatment of chronic periodontitis. Material and Methods Fifty-six papers were selected, reporting data from 52 different investigations. All the studies reported changes in probing pocket depth ( PPD) and clinical attachment level ( CAL) and most in plaque index (PlI) and/or bleeding on probing ( BOP). Meta-analyses were performed with the data retrieved from the studies fulfilling the inclusion criteria. Results The overall effect of the subgingival application of antimicrobials was statistically significant ( p = 0.000) for both changes in PPD and CAL with a weighted mean difference ( WMD) of −0.407 and −0.310 mm respectively. No significant differences occurred for changes in BOP and PlI. Subgingival application of tetracycline fibres, sustained released doxycycline and minocycline demonstrated a significant benefit in PPD reduction ( WMD between 0.5 and 0.7 mm). The rest of the tested outcomes demonstrated a high heterogeneity. The local application of chlorhexidine and metronidazole showed a minimal effect when compared with placebo ( WMD between 0.1 and 0.4 mm). Conclusions The scientific evidence supports the adjunctive use of local antimicrobials to debridement in deep or recurrent periodontal sites, mostly when using vehicles with proven sustained release of the antimicrobial. [ABSTRACT FROM AUTHOR]

Aim To systematically evaluate the efficacy of chlorhexidine ( CHX) mouthrinses on plaque, gingival inflammation and staining in gingivitis patients. Material & Methods Medline, EMBASE and Cochrane Central Register of Controlled Trials were searched through April 2011. Randomized controlled clinical trials comparing CHX to placebo/control mouthrinses or oral hygiene ( OH) ≥4 weeks were included. Results Among 1355 titles, 30 publications fulfilled the selection criteria. Meta-analysis ( MA) showed significant weighted mean differences ( WMD) favouring CHX. This was −0.39 [95% CI: −0.70; −0.08] for the Plaque Index Silness & Löe, −0.67 [95% CI: −0.82; −0.52] for the Plaque-Index Quigley & Hein ( PIQH), −0.32 [95% CI: −0.42; −0.23] for the Gingival Index ( GI), −0.08 [95% CI: −0.10; −0.05] for the bleeding aspect of the GI, −0.21 [95% CI: −0.37; −0.04] for the Papillary BIeeding Index, −0.16 [95% CI: −0.26; −0.07] for Bleeding on Marginal Probing and 0.91 [95% CI: 0.12;1.70] for the Lobene Stain Index. MA of studies with a low risk of author-estimated bias showed a WMD of −0.68 [95% CI: −0.85; −0.51] for the PIQH and −0.24 [95% CI: −0.29; −0.20] for the GI in favour of CHX. Relative to control, the reduction with CHX for plaque was 33% and for gingivitis 26%. CHX rinsing groups demonstrated significantly more staining. Conclusions In gingivitis patients, CHX mouthrinses together with OH versus placebo- or control mouthrinse provide significant reductions in plaque and gingivitis scores, but a significant increase in staining score. [ABSTRACT FROM AUTHOR]

Background: Periodontitis worsens the hyperglycaemia in patients with type 2 diabetes mellitus (T2DM). Subgingival instrumentation, with or without surgical access, is the gold‐standard treatment for periodontitis. The aim was to summarize the evidence on the effect of subgingival instrumentation (with or without open flap) on the reduction of glycosylated haemoglobin (HbA1c). Methods: Nine electronic databases were searched up to 15 February 2023. Twelve randomized controlled trials with at least 6 months of follow‐up were included. Studies using systemic or local‐delivery antimicrobial therapies were excluded. Meta‐analyses were performed using the random‐effects model. The sources of heterogeneity were assessed by applying linear meta‐regression. Risk of bias was assessed by RoB 2, and certainty of evidence by GRADE. Results: Eleven studies were included in the quantitative analyses (1374 patients). Subgingival instrumentation resulted in 0.29% lower HbA1c (95% confidence interval: 0.10–0.47; p =.03) compared with non‐active treatment. Discussion: None of the 12 studies were assessed as having low risk of bias. The percentage of females and the time of diabetes diagnosis significantly explained the high level of heterogeneity. Subgingival periodontal therapy results in a significant and clinically relevant improvement in glycaemic control over 6 months in patients with T2DM and periodontitis. The grade of evidence was moderate. [ABSTRACT FROM AUTHOR]

Aim: To examine the association between a pro‐inflammatory diet, estimated using the energy‐adjusted dietary inflammatory index (E‐DII), and the risk of periodontitis. Materials and Methods: Study subjects from the Korean Genome and Epidemiology Study Health Examinee (KoGES_HEXA) cohort were included for cross‐sectional analysis (n = 168,378) using multivariate logistic regression and prospective analysis (n = 160,397) using Cox proportional hazard models respectively. DII and E‐DII scores were calculated based on the intake reported on a validated semi‐quantitative food frequency questionnaire (SQ‐FFQ). Results: Cox proportional hazard models revealed a significantly increased risk of incident periodontitis in individuals consuming high E‐DII (more pro‐inflammatory) diets in the total population (HRquartile4vs1 = 1.29; 95% CI: 1.13–1.48; ptrend <.001) and in both men (HRquartile4vs1 = 1.36; 95% CI: 1.07–1.73; ptrend = 0.02) and women (HRquartile4vs1 = 1.27; 95% CI: 1.08–1.50; ptrend =.002). The association remained significant even after excluding cases diagnosed early in the follow‐up. In the cross‐sectional analysis, a significant association was observed between the E‐DII score and the prevalence of periodontitis among all study subjects (ORquartile4vs1 = 1.17; 95% CI: 1.03–1.34; ptrend = 0.01) and men (ORquartile4vs1 = 1.28; 95%CI: 1.01–1.63; ptrend <.001); however, the association did not reach statistical significance in women (ORquartile4vs1 = 1.13; 95% CI: 0.96–1.33; ptrend <.001). Conclusions: Findings from the current study support the hypothesis that diets with high pro‐inflammatory potential increase the risk of periodontitis. [ABSTRACT FROM AUTHOR]

Aim: To answer the following PICO question: In systemically healthy humans with peri‐implant mucositis, what is the efficacy of patient‐performed or administered (by prescription) measures used adjunctively to submarginal instrumentation, as compared to submarginal instrumentation alone or combined with a negative control, in terms of reducing bleeding on probing (BOP), in randomized controlled clinical trials (RCTs) with at least 3 months of follow‐up? Materials and Methods: Three databases were searched until April 2022. Weighted mean differences (WMDs) with 95% confidence intervals (CIs) and predictive intervals were calculated. Results: Sixteen parallel RCTs corresponding to 14 studies with low/moderate risk of bias were included. Test groups showed greater reductions in BOP (%) than control groups (nstudies = 16; npatients = 650; WMD = 14.25%; 95% CI [9.06–19.45]; p <.001; I2 = 98.7%). The greatest WMD in BOP reductions (%) were obtained by antiseptics (ns = 5; np = 229; WMD = 22.72%; 95% CI [19.40–26.04]; p < 0.001; I2 = 94.8%), followed by probiotics (ns = 6; np = 260; WMD = 12.11%; 95% CI [3.20–21.03]; p =.008; I2 = 93.3%) and systemic antibiotics (ns = 3; np = 101; WMD = 5.97%; 95% CI [1.34–10.59]; p =.012; I2 = 58.1%). Disease resolution was scarcely reported (n = 6). Conclusions: Significant clinical improvements can be obtained when professional submarginal instrumentation is combined with patient‐performed or administered (by prescription) adjunctive measures, although a complete disease resolution may not be achieved. [ABSTRACT FROM AUTHOR]

Aim: To answer the following PICOS question: "In adult patients with peri‐implantitis, what is the efficacy of surgical therapy with chemical surface decontamination of implant surfaces in comparison with surgical therapy alone or surgery with placebo decontamination, on probing pocket depth (PD) reduction and bleeding on probing (BoP)/suppuration on probing (SoP), in randomized controlled clinical trials (RCTs) and non‐RCTs with at least 6 months of follow‐up?" Materials and Methods: Six databases were searched from their inception up to 20 May 2022. Data on clinical outcome variables were pooled and analysed using mean differences (MDs), risk ratios (RRs), or risk differences (RDs) as appropriate, 95% confidence intervals (CIs), and prediction intervals (PIs) in the case of significant heterogeneity. Primary outcomes were determined as changes in PD and BoP/SoP. Secondary outcomes were radiographic marginal bone loss (MBL), implant loss, and disease resolution. PROSPERO registration number: CRD42022325603. Results: Six RCTs—two with moderate, three with high, and one with low risk of bias (RoB)—were included. These studies test the adjunctive effect of photodynamic therapy (PDT), chlorhexidine (CHX), and administration of local antibiotics (LAbs) during surgery on the clinical outcome. In a single 12‐month study, the adjunctive use of local antibiotics showed a clinically relevant reduction of PD [MD = 1.44; 95%CI (0.40 to −2.48)] and MBL [MD = 1.21; 95%CI (0.44–1.98); one trial, 32 participants]. PDT showed a small but significant reduction in BoP [MD = 7.41%; 95%CI (0.81–14.00); p = 0.028; two trials; 42 participants]. Treatment with CHX resulted in no significant changes in PD, BoP, or MBL compared to placebo (saline solution). None of the interventions affected disease resolution and implant loss. Certainty of the evidence was very low for all outcome measures assessed. Conclusions: Within the limitations of this systematic review and the meta‐analysis, adjunctive use of chemicals such as PDT, CHX, and LAbs for surface decontamination during surgery of peri‐implantitis cannot be recommended as superior to standard debridement procedures (mechanical debridement with or without saline). [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of access flap and pocket elimination procedures in the surgical treatment of peri‐implantitis. Materials and Methods: Systematic electronic searches (Central/MEDLINE/EMBASE) up to March 2022 were conducted to identify prospective clinical studies evaluating surgical therapy (access flap or pocket elimination procedures) of peri‐implantitis. Primary outcome measures were reduction of probing depth (PD) and bleeding on probing (BOP). Risk of bias was evaluated according to study design. Meta‐analysis and meta‐regression were performed. Results were expressed as standardized mean effect with 95% confidence interval (CI). Results: Evidence from studies directly comparing surgical with non‐surgical therapy is lacking. Based on pre‐post data originating from 13 prospective patient cohorts, pronounced reductions of PD (standardized mean effect: 2.2 mm; 95% CI 1.8–2.7) and BOP% (27.0; 95% CI 19.8–34.2) as well as marginal bone level gain (0.2 mm; 95% CI –0.0 to 0.5) were observed at evaluation time points ranging from 1 to 5 years. Wide prediction intervals suggested a high degree of heterogeneity. Reduction of mean PD increased by 0.7 mm (95% CI 0.5–0.9) for every millimetre in increase of mean PD at baseline. During the follow‐up period ranging from 1 to 5 years, disease recurrence occurred frequently and implant loss was not uncommon. Conclusions: Access flap and pocket elimination surgery are effective procedures in the management of peri‐implantitis, although rates of disease recurrence during 5 years were high. Treatment outcomes were affected by baseline conditions. [ABSTRACT FROM AUTHOR]

Aim: To evaluate (1) whether periodontitis has an influence on the prevalence/incidence of respiratory diseases (chronic obstructive pulmonary disease [COPD], asthma, community‐acquired pneumonia [CAP], obstructive sleep apnoea [OSA] and COVID‐19), and (2) what is the impact of periodontal therapy on the onset or progression of respiratory diseases. Materials and Methods: An electronic search was performed on Pubmed, Cochrane Library and Scopus databases up to October 2021, to identify studies answering the PECOS and PICOS questions. Results: Seventy‐five articles were selected. Meta‐analyses identified statistically significant associations of periodontitis with COPD (nstudies = 12, odds ratio [OR] = 1.28, 95% confidence interval [CI] [1.16; 1.42], p <.001), and OSA (ns = 6, OR = 1.65, 95% CI [1.21; 2.25], p =.001), but not for asthma (ns = 9, OR = 1.53, 95% CI [0.82; 2.86], p =.181). For acute conditions, two studies were found for CAP, while for COVID‐19, significant associations were found for the need of assisted ventilation (ns = 2, OR = 6.24, 95% CI [2.78; 13.99], p <.001) and COVID‐related mortality (ns = 3, OR = 2.26, 95% CI [1.36, 3.77], p =.002). Only four intervention studies were found, showing positive effects of periodontal treatment on COPD, asthma and CAP. Conclusions: A positive association between periodontitis and COPD, OSA and COVID‐19 complications has been found, while there is a lack of intervention studies. [ABSTRACT FROM AUTHOR]

Aim: To investigate the relationship between plant‐based diet indices (PDIs) and periodontitis and serum IgG antibodies against periodontopathogens in the U.S. population. Materials and Methods: We analysed cross‐sectional data on 5651 participants ≥40 years of age from the Third National Health and Nutrition Examination Survey. Food frequency questionnaire data were used to calculate the overall PDI, healthy plant‐based diet index (hPDI), and unhealthy plant‐based diet index (uPDI). Periodontitis was defined using a half‐reduced Centers for Disease Control and Prevention and American Academy of Periodontology case definition. Serum antibodies against 19 periodontopathogens were used to classify the population into two subgroups using hierarchical clustering. Survey‐weighted multivariable logistic regressions were applied to assess the associations of PDI/hPDI/uPDI z‐scores with periodontitis and hierarchical clusters after adjusting for potential confounders. Results: A total of 2841 (50.3%) participants were defined as having moderate/severe periodontitis. The overall PDI z‐score was not significantly associated with the clinical and bacterial markers of periodontitis. By considering the healthiness of plant foods, we observed an inverse association between hPDI z‐score and periodontitis (odds ratio [OR] = 0.925, 95% confidence interval [CI]: 0.860–0.995). In contrast, higher uPDI z‐score (adherence to unhealthful plant foods) might increase the risk of periodontitis (OR = 1.100; 95% CI: 1.043–1.161). Regarding antibodies against periodontopathogens, the participants in cluster 2 had higher periodontal antibodies than those in cluster 1. The hPDI z‐score was positively associated with cluster 2 (OR = 1.192; 95% CI: 1.112–1.278). In contrast, an inverse association between uPDI z‐score and cluster 2 was found (OR = 0.834; 95% CI: 0.775–0.896). Conclusions: Plant‐based diets were associated with periodontitis, depending on their quality. A healthy plant‐based diet was inversely related to an increased risk of periodontitis but positively related to elevated antibody levels against periodontopathogens. For an unhealthy plant‐based diet, the opposite trends were observed. [ABSTRACT FROM AUTHOR]

Aim: To assess the effect of cognition on the loss of functional dentition. Materials and Methods: We used data from the three waves of the Panel on Health and Ageing of Singaporean Elderly study (n = 4990 at baseline, 774 complete cases analysed) over 6 years (2009–2015). The outcome was the loss of functional dentition (<21 teeth). The exposure was cognitive impairment, while baseline confounders included age, sex, education, and ethnicity. Time‐varying confounders included income, living arrangements, smoking, diabetes, depressive symptoms, cardiovascular disease, and body mass index. We used marginal structural mean models with inverse probability treatment weighted. Results: The mean age of the participants was 70.2 years at baseline. The proportion of participants with loss of functional dentition increased from 74.6% to 89.9% over 6 years. Women, ethnic Chinese, less educated, smokers, people with diabetes, and individuals with depression had a higher proportion of loss of functional dentition than their counterparts. Loss of functional dentition was 1.8 times higher (odds ratio 1.80; 95% confidence interval 0.88–3.69) among those with cognitive impairment after taking well‐known confounders into account. Conclusions: After accounting for the time‐varying exposure and confounding evidence, the association between cognition and functional dentition among the elderly in Singapore remains uncertain. [ABSTRACT FROM AUTHOR]

Aim: To assess any differences (1) in the prevalence of periodontitis and necrotizing periodontal diseases, specifically necrotizing gingivitis (NG) and necrotizing periodontitis (NP) between HIV patients receiving antiretroviral therapy (HAART) and those not receiving the therapy and (2) in the severity of periodontitis based on probing depths (PDs) and clinical attachment loss (CAL) between the two groups. Materials and Methods: Systematic electronic search on five databases (PubMed, Google Scholar, Scopus, Web of Science and Scielo) was conducted to identify cross‐sectional and longitudinal studies reporting on prevalence of NG, NP and periodontitis among HIV patients who either receive or do not receive HAART treatment. The differences in clinical parameters of PDs and CAL among these patients were assessed. Results: Eighteen articles were considered. The meta‐analysis for NG showed that the overall assessment for the relative frequency ratio in the two groups was 0.45 (n = 7; 95% confidence interval [CI]: [0.21, 0.97]; p <.042). Regarding NP, the overall assessment for the relative frequency ratio in both groups was 0.60 (n = 5; 95% CI [0.22, 1.64]; p =.321). With regard to periodontitis, the overall assessment for the relative frequency ratio in the two groups was 1.17 (n = 9; 95% CI [0.90, 1.52]; p =.248). No significant differences in PD and CAL were found between the two groups 0.00 (n = 3; 95% CI [−0.52, –0.53]; p =.985) and 0.32 (n = 3; 95% CI [−0.19, 0.82]; p =.22), respectively. Conclusions: The prevalence of NG appeared to be significantly reduced in patients receiving antiretroviral therapy. No statistical significant difference was found in the prevalence of NP or periodontitis between the two groups. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association of the number of natural teeth with overall dietary diversity and nutritional status in a nationally representative study among older adults in China. Materials and Methods: A cross‐sectional analysis was conducted among community‐dwelling adults aged 65 years or older from the Chinese Longitudinal Healthy Longevity Study. According to the self‐reported number of natural teeth, participants were categorized into ≥20, 10–19, 1–9 natural teeth, and edentulous. Dietary diversity score (DDS) was constructed based on intake frequencies of 10 food groups assessed by a simplified food frequency questionnaire. The geriatric nutritional risk index was used to measure the malnutrition status (i.e., normal, mild malnutrition, and moderate‐to‐severe malnutrition) among a subgroup of participants. Linear and multinomial logistic regression models were used to examine the corresponding associations. Results: Among 54,796 study participants, the mean (SD) age was 87.86 (11.45) years, 82.7% had poor dentition (<20 natural teeth), and 27.3% wore dentures. After multivariable adjustment, participants with poor dentition had lower DDSs (βedentulous = −0.39, 95% confidence interval [CI], −0.48, −0.30; β1‐9 teeth = −0.46, 95% CI, −0.55, −0.37; β10‐19 teeth = −0.36, 95% CI, −0.46, −0.26) than those with 20 natural teeth or more. For individual food items, edentulous, 1–9 and 10–19 natural teeth were associated with lower odds of regular intake of fresh fruits, fresh vegetables, meat, fish and aquatic products, eggs, legumes, preserved vegetables, tea, and garlic, but higher odds of regular intake of sugar and sweets. Among participants with poor dentition, individuals without dentures had lower intake frequencies of most food groups than those wearing dentures. In addition, poor dentition was related to lower odds of normal nutritional status (odds ratio = 0.49, 95% CI, 0.27, 0.89). Conclusions: Older adults with poor dentition had significantly lower dietary diversity and worse nutritional status. Future studies are warranted to identify effective interventions to improve the dietary quality and nutrition status among partially and fully edentulous individuals, including those with Stage IV periodontitis. [ABSTRACT FROM AUTHOR]

Aim: Epidemiological and pre‐clinical studies suggest a chemoprotective role of lipid‐lowering agents in periodontitis. We tested the association of genetically proxied inhibition of 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase (HMGCR), Niemann‐Pick C1‐Like 1 (NPC1L1) and proprotein convertase subtilisin/kexin type 9 (PCSK9) with periodontitis. Materials and Methods: Genetic variants in HMGCR, NCP1L1 and PCSK9 associated with low‐density lipoprotein (LDL) cholesterol in a genome‐wide association study (GWAS) meta‐analysis (N = 188,578) were used to proxy therapeutic inhibition of HMGCR, NPC1L1 and PCSK9. For these genetic variants, associations with periodontitis were obtained from GWAS of 17,353 cases and 28,210 controls in the GeneLifestyle Interactions in Dental Endpoints consortium. Generalized weighted least squares analysis accounted for linkage disequilibrium of genotypes to derive pooled estimates. Results: While genetically proxied HMGCR inhibition equivalent to 1 mmol/L reduction in LDL was not associated with odds of periodontitis (odds ratio [OR] = 0.92 [95% confidence interval [CI]: 0.73; 1.16]; p =.4905; false discovery rate [FDR] = 0.4905), genetically proxied NPC1L1 (OR = 0.53 [95% CI: 0.35; 0.81]; p =.0038; FDR = 0.0077) and PCSK9 (OR = 0.84 [95% CI: 0.74; 0.95]; p =.0051; FDR = 0.0077) inhibition lowered the odds of periodontitis. Conclusions: Genetically proxied inhibition of NCP1L1 and PCSK9 was associated with lower odds of periodontitis. [ABSTRACT FROM AUTHOR]

Background: Systemic inflammation is implicated in the onset and progression of several chronic diseases. Periodontitis is a potential trigger of systemic inflammation. Purpose: To comprehensively appraise all the evidence on the effects of the treatment of periodontitis on systemic inflammation assessed by serum C‐reactive protein (CRP) levels. Data Sources: Six electronic databases were searched up to 10 February 2022 to identify and select articles in English language only. Study Selection: Twenty‐six randomized controlled clinical trials reporting changes amongst 2579 participants about CRP levels at 6 months or more after treatment. Data Extraction: Two reviewers independently extracted data and rated the quality of studies. Meta‐analyses were performed using random and fixed effect models. Risk of Bias: Risk of bias (RoB 2.0 tool) and quality of evidence (GRADEpro GDT tool) analyses were completed. Data Synthesis: Treatment of periodontitis reduced CRP levels by 0.69 mg/L (95% confidence interval: −0.97 to −0.40) after 6 months, but limited evidence was retrieved from studies with longer follow‐ups. Similar findings were observed in participants with other co‐morbidities in addition to periodontitis. Greatest reductions were observed in participants with concentrations of CRP >3 mg/L at baseline. Limitations: High level of heterogeneity. Conclusions: Treatment of periodontitis reduces serum CRP levels (up to 6 months follow‐up) to a degree equivalent to that observed after traditional lifestyle or drug interventions. This evidence supports a causal association between periodontitis and systemic inflammation. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the clinical non‐inferiority of a 3‐day protocol of systemic antibiotics adjunctive to subgingival instrumentation (SI) compared with a 7‐day‐protocol in patients with Stage III/IV Grade C periodontitis. Materials and Methods: Fifty systemically healthy patients (32.7 ± 4.3 years) with aggressive periodontitis (AgP; Stage III/IV Grade C periodontitis) were treated by SI and adjunctive amoxicillin and metronidazole and were randomly assigned to Group A: (n = 25) 500 mg antibiotics (AB) 3 times a day for 3 days, followed by placebo 3 times a day for 4 days, or Group B: (n = 25) 500 mg AB 3 times a day for 7 days. Clinical, microbial, and immunological parameters were assessed at baseline, 3 months, and 6 months, and patient‐related outcomes were assessed after 2 weeks. The primary outcome variable was the number of residual sites with pocket depth (PD) ≥6 mm at 6 months. Results: For the primary outcome variable (the number of residual sites with PD ≥6 mm at 6 months), the null hypothesis was rejected and non‐inferiority of the 3‐day AB protocol compared with the 7‐day AB protocol was demonstrated (the upper limits of the 95% confidence interval for intention to treat analysis: [−2.572; 1.050] and per protocol analysis: [−2.523; 1.318] were lower than the assumed margin of Δ = 3.1). Comparable clinical improvements were obtained for all parameters with both antibiotic protocols (p >.05). All investigated periodontopathogens and pro‐inflammatory host‐derived markers were statistically significantly reduced without differences between the treatments (p >.05). Conclusions: These findings indicate that in patients with AgP (Stage III/IV Grade C periodontitis), a 3‐day systemic administration of amoxicillin and metronidazole adjunctive to SI may lead to non‐inferior clinical outcomes after 6‐months with fewer adverse events compared with a 7‐day‐protocol. [ABSTRACT FROM AUTHOR]

Aim: To assess the effect of immediate provisionalization (IP) on soft tissue changes, hard tissue changes, and clinical parameters following single immediate implant placement (IIP). Materials and Methods: Two independent reviewers conducted an electronic literature search in PubMed, Web of Science, Embase, and Cochrane databases as well as a manual search to identify eligible clinical studies up to September 2021. Randomized controlled trials (RCTs) comparing IIP with IP (test) and IIP without IP (control) were included for a qualitative and quantitative analysis. The primary outcome was vertical midfacial soft tissue changes. Secondary outcomes included horizontal midfacial soft tissue changes, implant survival, mesial and distal papillary changes, Pink Esthetic Score (PES) at final follow‐up, marginal bone‐level changes, probing depth at final follow‐up, and bleeding on probing at final follow‐up. Results: Of the 8213 records, 7 RCTs reporting on 323 patients who received 323 single immediate implants (IIP + IP: 161 implants in 161 patients; IIP: 162 implants in 162 patients) were selected with a mean follow‐up ranging from 12 to 60 months. Risk of bias assessment yielded some concerns for five RCTs and high risk for two RCTs. Meta‐analysis on the cases with intact alveoli demonstrated 0.87 mm (95% confidence interval [CI] [0.57; 1.17], p <.001) less apical migration of the midfacial soft tissue level for IIP + IP when compared to IIP alone. Implant survival, papillary changes, marginal bone‐level changes, probing depth, and bleeding on probing were not significantly affected by IP. Insufficient data were available for meta‐analyses on horizontal midfacial soft tissue changes and PES. Conclusions: IP may contribute to midfacial soft tissue stability at immediate implants. However, high‐quality RCTs are needed since the strength of this conclusion is currently rated as low according to GRADE guidelines. [ABSTRACT FROM AUTHOR]

Aim: To compare connective tissue graft (CTG) with collagen matrix (CMX) in terms of increase in buccal soft tissue profile (BSP) at 1 year when applied at single implant sites. Materials and Methods: Patients with a single tooth gap in the anterior maxilla and horizontal mucosa defect were enrolled in a multi‐centre randomized controlled trial. All sites had a bucco‐palatal bone dimension of at least 6 mm, received a single implant and an immediate implant restoration using a full digital workflow. Sites were randomly allocated to the control (CTG) or test group (CMX) to increase buccal soft tissue thickness. The primary outcome was the increase in BSP at 1 year when compared with the pre‐operative situation based on superimposed digital surface models. The changes in BSP over time were registered at a buccal area of interest reaching from 0.5 mm below the soft tissue margin to 4 mm more apical. Secondary outcomes included patient‐reported, clinical and aesthetic outcomes. Results: Thirty patients were included per group (control: 50% females, mean age 50.1; test: 53% females, mean age 48.2). The increase in BSP at 1 year was 0.98 mm (98.3% confidence interval [CI]: 0.75–1.20) for CTG and 0.57 mm (98.3% CI: 0.34 to 0.79) for CMX. The mean difference of 0.41 mm (98.3% CI: 0.12 to 0.69) in favour of CTG was significant (p <.001). Based on an arbitrarily chosen threshold for success of 0.75 mm increase in BSP, 89.7% of the patients in the control group and 10% of the patients in the test group were successfully treated (odds ratio = 77.90; 95% CI: 13.52 to 448.80; p <.001). Sites treated with CMX demonstrated 0.89 mm (98.3% CI: 0.49 to 1.30) more shrinkage between postop and 1 year than sites treated with CTG. In addition, CMX resulted in significantly more marginal bone loss (0.39 mm; 95% CI: 0.05 to 0.74; p =.026) than CTG. There were no significant differences between the groups in terms of patients' aesthetic satisfaction (p =.938), probing depth (p =.917), plaque (p =.354), bleeding on probing (p =.783), midfacial recession (p =.915), Pink Esthetic Score (p =.121) and Mucosal Scarring Index (p =.965). Conclusions: CTG remains the gold standard to increase soft tissue thickness at implant sites. Clinicians need to outweigh the benefits of CMX against considerable resorption of the graft. This study was registered in ClinicalTrials.gov (NCT04210596). [ABSTRACT FROM AUTHOR]

Aim: The presence of periodontal disease (PD) at a single time point has been suggested as a predictor of diabetes risk, but whether changes in PD status are associated with altered risk of diabetes is yet to be reported on a population scale. This study investigated whether recovery from or development of PD in a population is associated with an altered risk of diabetes occurrence. Materials and Methods: Data of subjects who received health screening from 2002 to 2007 were obtained from the National Health Insurance Service–National Health Screening cohort database of Korea. Patients with a history of diabetes were excluded. Changes in PD status were determined from the first two health screenings. Study subjects were divided into four groups according to the changes in PD status: PD‐free, PD‐recovered, PD‐developed, and PD‐chronic. The outcome was the occurrence of diabetes. Results: Overall, 111,611 subjects were included for analysis. During a median follow‐up of 9.10 years, diabetes developed in 6102 subjects. The adjusted hazard ratios (HRs) for incident diabetes across various PD change groups (in reference to the PD‐free group) were as follows: PD‐chronic group = 1.096 (95% confidence interval [CI] 1.026–1.170, p =.006); PD‐developed group = 1.073 (95% CI 0.993–1.159, p =.075); and PD‐recovered group = 1.019 (95% CI 0.945–1.100, p =.622). The subjects who recovered from PD had a lower diabetes risk than those who had consistent PD (adjusted HR 0.930, 95% CI 0.865–1.000, p =.050), whereas those who developed PD had a higher risk of diabetes than those who remained PD‐free. Conclusion: The longitudinal change in PD status is associated with incident diabetes risk. Future intervention studies are necessary to determine whether PD treatment can prevent incident diabetes. [ABSTRACT FROM AUTHOR]

Aim: Periodontal disease is one of the most prevalent oral pathologies and a major chronic disease worldwide. Lifestyle habits such as poor nutrition and smoking have been established to contribute to the development of periodontal disease, but limited research has investigated whether physical activity and sedentary lifestyle play a role. The purpose of this study is to evaluate the association between physical activity, sedentary behaviour, and periodontal disease. Materials and Methods: We used a nationally representative data set from the National Health and Nutrition Examination Survey (NHANES) 2011–2012. We examined the association between physical activity and sedentary behaviour and periodontal disease using multivariable logistic regression models and reported odds ratios (ORs). Results: Individuals with higher total physical activity, higher leisure time physical activity, and lower amount of total sedentary behaviour had lower periodontal disease prevalence. Adjusted multivariable regression models showed that higher sedentary behaviour (more than 7.5 h/day) was associated with higher odds of periodontal disease (OR = 1.17; 95% confidence interval = 1.00–1.36; p =.045). Conclusions: The findings showed that higher sedentary behaviour is associated with higher odds of periodontal disease. Future prospective longitudinal studies and strategies are needed to investigate implications further and define the magnitude of the association between physical activity and periodontal disease. [ABSTRACT FROM AUTHOR]

Aim: To assess the effect of surgical root coverage (RC) on dentin hypersensitivity (DH) associated with gingival recession. Materials and Methods: Two independent reviewers conducted electronic literature searches in MEDLINE (PubMed), EMBASE, Cochrane Library, Web Of Science, Dentistry & Oral Sciences Source, ScienceDirect, and ClinicalTrials.gov databases as well as a manual search to identify eligible clinical studies from January 2000 to March 2022. Randomized controlled trials (RCTs) comparing two surgical RC techniques or a surgical RC technique with or without adjuvant were included. Meta‐analyses were performed on data provided by RCTs. Results: Thirteen RCTs with a total of 701 patients (1086 recessions) were included. The percentage of DH suppression was 70.8% (95% confidence interval [CI] [64.4–76.6]; I2 = 39.2% [3.5–61.8], Q‐test = 0.02) after surgical RC. Recession reduction and percentage of RC were both statistically significantly associated with DH suppression (estimate = 0.66 [0.10–1.23], p =.022, R2 = 14.45% and estimate = 0.04 [0.01–0.08], p =.012, R2 = 29.54%, respectively). Coronally advanced flap (CAF) + connective tissue graft showed results statistically more effective than CAF + xenogeneic collagen matrix in DH suppression (73.3% [65.6–79.8] and 61.4% [51.7–70.3], respectively; p =.048). Conclusions: Success of surgical RC is associated with DH suppression. [ABSTRACT FROM AUTHOR]

Aim: This randomized placebo‐controlled clinical trial evaluated the effects of multispecies probiotic containing Lactobacillus rhamnosus HN001™, Lactobacillus paracasei Lpc‐37®, and Bifidobacterium animalis subsp lactis HN019™ as an adjunct to mechanical debridement (MD) on changes in bleeding on probing (BOP) in edentulous patients with peri‐implant mucositis (PiM). Materials and Methods: Patients were randomly assigned to test (probiotic) or control (placebo) groups. All sites with PiM received MD and topical gel application (probiotic or placebo) at baseline and 12 weeks. After initial MD, patients consumed probiotic or placebo capsules twice a day for 12 weeks. Clinical (modified sulcus bleeding index [mSBI]; modified plaque index [mPI]; probing depth [PD]; and BOP) and immunological parameters were collected at baseline and after 12 and 24 weeks. Data were statistically analysed (p <.05). Results: Thirty‐six patients with PiM were recruited. The test group presented higher prevalence (p <.05) of cases of restored peri‐implant health at 24 weeks than did the control group (72.2% and 33.3%, respectively). No significant difference was observed between test (n = 18) and control (n = 18) groups for mPI and PD. mSBI %—score 0 was higher in the test group than in the control group at 24 weeks (p <.05). When compared with baseline, both groups presented reduced BOP at 12 and 24 weeks (p <.05). BOP was lower in the test group than in the control group at 12 (mean difference = −14.54%; 95% confidence interval [CI] = −28.87 to 0.22; p =.0163) and 24 (mean difference = −12.56%; 95% CI = −26.51 to 1.37; p =.0090) weeks. At 24 weeks, only the test group presented lower levels of interleukin (IL)‐1β, IL‐6, IL‐8, and tumour necrosis factor (TNF)‐α than those at baseline (p <.05). Conclusions: The multispecies probiotic (administered locally and systemically) containing L. rhamnosus HN001™, L. paracasei Lpc‐37®, and B. lactis HN019™ as an adjunct to repeated MD promotes additional clinical and immunological benefits in the treatment of PiM in edentulous patients (ClinicalTrials.gov NCT04187222). [ABSTRACT FROM AUTHOR]

Aim: To systematically review the literature to evaluate the recurrence of disease of people in long-term supportive periodontal care (SPC), previously treated for periodontitis, and determine the effect of different methods of managing recurrence. The review focused on stage IV periodontitis. Materials and methods: An electronic search was conducted (until May 2020) for prospective clinical trials. Tooth loss was the primary outcome. Results: Twenty-four publications were retrieved to address recurrence of disease in long-term SPC. Eight studies were included in the meta-analyses for tooth loss, and three studies for disease progression/recurrence (clinical attachment level [CAL] loss ≥2 mm). For patients in SPC of 5-20 years, prevalence of losing more than one tooth was 9.6% (95% confidence interval [CI] 5%-14%), while experiencing more than one site of CAL loss ≥2 mm was 24.8% (95% CI 11%-38%). Six studies informed on the effect of different methods of managing recurrence, with no clear evidence of superiority between methods. No data was found specifically for stage IV periodontitis. Conclusions: A small proportion of patients with stage III/IV periodontitis will experience tooth loss in long-term SPC (tendency for greater prevalence with time). Regular SPC appears to be important for reduction of tooth loss. No superior method to manage disease recurrence was found. [ABSTRACT FROM AUTHOR]

Aim: The aim was to evaluate the efficacy and effectiveness of tooth-supported fixed prostheses in partially edentulous patients with stage IV periodontitis. Material and Methods: Randomized and controlled clinical trials (RCTs and CCTs) and prospective/retrospective cohort studies or case series were searched in three databases. Survival rate of abutment teeth was considered the primary outcome. Meta-analyses were performed whenever possible. Results: Twenty-four publications were included. No RCTs or CCTs compared the efficacy of tooth-supported fixed prostheses between patients with severe periodontitis or non-periodontitis patients. Most of the data retrieved were derived from case series. The incidence of abutment-tooth loss after a follow-up period from 2 to 35.4 years was low (n = 17 studies; weighted mean incidence (WMI) = 4.8%; confidence interval (CI) [3.2, 6.5]). The corresponding figure for prostheses failure was WMI = 6.9% (n = 18; 95% CI [4.1, 9.7]). Technical complications seemed to be more frequent than biological complications (caries, endodontic failure, root fracture, etc.). Periodontal outcomes tended to remain stable over time. Conclusion: Tooth-supported fixed prostheses seemed to be a valid treatment approach to restore masticatory function in patients with stage IV periodontitis once periodontal therapy has been accomplished. However, the comparative efficacy of this treatment among periodontitis and non-periodontitis patients is unclear due to the absence of clinical trials. [ABSTRACT FROM AUTHOR]

Aim: To answer these PICO questions: #1: In adult patients with malocclusion, what are the effects of orthodontic tooth movement (OTM) on clinical attachment level (CAL) changes in treated periodontitis patients with a healthy but reduced periodontium compared to non-periodontitis patients? #2: In adult patients with treated periodontitis and malocclusion, which is the efficacy of skeletal anchorage devices compared to conventional systems in terms of orthodontic treatment outcomes? Material and methods: Seven databases were searched until June 2020 looking for randomized, non-randomized trials and case series. Mean effects (ME) and 95% confidence intervals (CIs) were calculated. Results: Twenty-six studies with high risk of bias were included. PICO#1: In 26 patients without periodontitis and in 69 treated periodontitis patients, minimal changes in periodontal outcomes were reported after orthodontic therapy (p > 0.05). A significant CAL gain (mm) (ME = 3.523; 95% CI [2.353; 4.693]; p < 0.001) was observed in 214 patients when periodontal outcomes were retrieved before a combined periodontal and orthodontic therapy. PICO#2: Orthodontic variables were scarcely reported, and objective assessment of the results on orthodontic therapy was missing. Conclusions: Based on a small number of low-quality studies, in non-periodontitis and in stable treated periodontitis patients, OTM had no significant impact on periodontal outcomes. [ABSTRACT FROM AUTHOR]

Aim: To assess the beneficial and adverse effects on the dental and periodontal issues of periodontal–orthodontic treatment of teeth with pathological tooth flaring, drifting, and elongation in patients with severe periodontitis. Materials and methods: Nine databases were searched in April 2020 for randomized/non‐randomized clinical studies. After duplicate study selection, data extraction, and risk‐of‐bias assessment, random‐effect meta‐analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta‐regression analyses. Results: A total of 30 randomized and non‐randomized clinical studies including 914 patients (29.7% male; mean age 43.4 years) were identified. Orthodontic treatment of pathologically migrated teeth was associated with clinical attachment gain (−0.24 mm; seven studies), pocket probing depth reduction (−0.23 mm; seven studies), marginal bone gain (−0.36 mm; seven studies), and papilla height gain (−1.42 mm; two studies) without considerable adverse effects, while patient sex, gingival phenotype, baseline disease severity, interval between periodontal and orthodontic treatment, and orthodontic treatment duration affected the results. Greater marginal bone level gains were seen by additional circumferential fiberotomy (two studies; MD = –0.98 mm; 95% CI = –1.87 to −0.10 mm; p =.03), but the quality of evidence was low. Conclusions: Limited evidence of poor quality indicates that orthodontic treatment might be associated with small improvements of periodontal parameters, which do not seem to affect prognosis, but more research is needed. [ABSTRACT FROM AUTHOR]

Aim: This Mendelian randomization (MR) study was performed to explore the causal relationship among circulating vitamin C and D levels, dental caries, and periodontitis. Materials and Methods: MR analyses were conducted with the inverse variance weighted (IVW) method, weighted median, MR‐Egger approaches, and MR‐robust adjusted profile score method to assess the causal relationships between circulating vitamin C and D concentrations and dental caries, the number of remaining natural permanent teeth in the mouth (N teeth), and periodontitis. Results: We found potential causal association of circulating vitamin D concentrations with N teeth (β = 0.085; 95% confidence interval: 0.019 to 0.150; p =.012) based on the IVW method. No significant causal relationship between circulating vitamin D levels and dental caries and periodontitis was observed. Similarly, no evidence supported a causal relationship between circulating vitamin C concentrations and the risk of dental caries, N teeth, and periodontitis. Conclusions: There is no obvious evidence suggesting a causal relationship among circulating vitamin D, dental caries, and periodontitis, drawing into question the mechanism for any association with N teeth. Additionally, there is insufficient power to detect small effects in vitamin C levels and caries and periodontitis. [ABSTRACT FROM AUTHOR]

Aim: Periodontitis has been proposed to lead to Helicobacter pylori infection, which could cause many gastrointestinal tract cancers. This study aimed to determine the association or otherwise between periodontitis and survival outcomes in individuals with respect to H. pylori infection. Materials and Methods: The study population comprised 4955 subjects aged 20–90 who had received both periodontal examination and H. pylori serum test in the Third National Health and Nutrition Examination Survey (NHANES III) database. Logistic regression models were used to analyse the association between periodontitis and H. pylori seropositivity (H. pylori infection). Survival analysis was performed using the NHANES III linked to mortality data. Cox proportional hazard regression was carried out to investigate the association between periodontitis and gastrointestinal tract cancer mortality in individuals with/without H. pylori infection. Results: Compared to periodontal health, periodontitis was significantly associated with increased odds of H. pylori infection (OR = 1.271, 95% CI = 1.177–1.372). Periodontitis significantly increased the mortality risk from all causes (HR = 1.574, 95% CI = 1.327–1.866) and all cancers (HR = 1.948, 95% CI = 1.701–2.232), including gastrointestinal (GI) tract cancer (HR = 4.140, 95% CI = 3.656–4.687), gastric cancer (HR = 4.288, 95% CI = 3.969–4.632), and colorectal cancer (HR = 4.814, 95% CI = 3.849–6.020) in subjects with H. pylori infection after adjusting for health‐related factors. Periodontitis was significantly related to the decreased survival time in subjects with GI tract (p =.001) or colorectal cancer (p =.002) and H. pylori infection. Conclusion: Our study demonstrated that periodontitis was significantly associated with higher mortality risk of GI tract, gastric, and colorectal cancer in subjects with H. pylori infection. Owing to an interactive effect between periodontitis and H. pylori infection on cancer mortality, H. pylori infection has a significant moderating effect in regulating the association between periodontitis and mortality due to all cancers, including GI tract cancer and colorectal cancer. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate the robustness of the observations on the influence of oral hygiene, gingival and periodontal status on the development of bacteraemia from everyday oral activities ( B-EOA), analysing its prevalence, duration, magnitude and bacterial diversity. Material and Methods: This systematic review/meta-analysis complies with PRISMA reporting guidelines. MEDLINE-PubMed, the Cochrane Library and Embase were explored for detecting studies on B-EOA. Results: There were 290 potentially eligible articles, of which 12 article on B-EOA fulfilled the inclusion criteria and were processed for data extraction (seven on toothbrushing, one on dental flossing and four on chewing). Evaluating the influence of plaque and gingival indices on the prevalence of bacteraemia following toothbrushing, the pooled odds ratios were 2.61 [95% confidence interval ( CI) = 1.45-4.69] and 2.77 (95% CI = 1.50-5.11), respectively. None of five studies on bacteraemia following dental flossing and chewing revealed a statistically significant association between oral hygiene, gingival or periodontal status and the development of bacteraemia. Conclusions: Meta-analysis showed that plaque accumulation and gingival inflammation scores significantly increased the prevalence of bacteraemia following toothbrushing. However, systematic review showed no relationship between oral hygiene, gingival and periodontal status and the development of B-chewing, and there is no evidence that gingival and periodontal health status affects B-flossing. [ABSTRACT FROM AUTHOR]

Introduction: Evidence of an association between periodontitis and MetS (metabolic syndrome) remains controversial. The objective of this study is to evaluate the association between periodontitis and MetS in a cross‐sectional population survey. Material and Methods: WORALTH (Workers' ORAL healTH) Study is a cross‐sectional survey, conducted on a representative sample of the Spanish employed population, including 5154 participants. An oral examination following the World Health Organization (WHO) criteria evaluated the periodontal status using the Community Periodontal Index (CPI) and Clinical Attachment Levels (CAL). Logistic regression analysis with adjustment for potential confounders was used to evaluate the association between periodontitis and MetS, and its individual components. Results: Participants presenting a CPI = 4 were more likely to have MetS than subjects with CPI < 4 [odds ratio, OR = 1.41; 95% confidence interval (CI) 1.10–1.81; p < 0.001]. High blood pressure was the component with stronger association with periodontal status (OR = 1.94 for CAL ≥6 mm; 95% CI 1.49–2.53; p < 0.001). After stratifying for sex, the association was higher in women (OR = 2.20 for CPI = 4; 95% CI 1.31–3.62; p < 0.001). Non‐metabolically healthy subjects, obese or not, presented a worse periodontal condition. Conclusion: Severe periodontitis (CPI = 4) was associated with MetS in a representative sample of the Spanish employed population. This association seems to be independent of body mass index and other potential confounders. [ABSTRACT FROM AUTHOR]

Aim: To systematically review buccal bone thickness (BBT) in the anterior maxilla in different teeth, age groups and genders. Materials and Methods: PubMed, EMBASE and Cochrane databases were searched up to April 2020. Clinical and radiographic studies reporting on BBT of maxillary anterior teeth, with at least 10 patients, were included. A meta‐analysis was performed using random effect models to report differences of BBT. Results: 50 studies were included. Using bone crest (BC) as a reference point, no significant differences were found in BBT between different tooth types, except for 0.16 mm (95%‐CI: 0.02–0.30) increased mid‐root thickness of premolars compared to canines. Using the CEJ as a reference point, canines presented with a significantly increased thickness of 0.32 mm (95%‐CI: 0.11–0.54) coronally compared to laterals. When BC was used as reference, males demonstrated a significantly increased thickness of 0.21 mm (95%‐CI: 0.15–0.27) apically, while middle‐aged adults showed a 0.06 mm (95%‐CI: −0.12, −0.01) statistically significant increase in the coronal level compared to older adults. Conclusions: Few maxillary anterior teeth have BBT greater than 1 mm. Buccal bone tends to get thicker from a coronal to apical position along the root surface and from an anterior to posterior position in the arch. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study is to assess the associations between periodontal disease, tooth loss and liver diseases. Materials and methods: PubMed and Embase databases were utilized to search eligible studies. Odds ratio (OR) with 95% confidence interval (CI) was used as effect size to assess the associations between periodontal disease, tooth loss and liver diseases risk. Results: Our results indicated positive associations between periodontal disease and non‐alcoholic fatty liver disease (NAFLD) (OR = 1.19, 95% CI = 1.06–1.33), liver cirrhosis (OR = 2.28, 95% CI = 1.50–3.48) and elevated transaminase level risk (OR = 1.08, 95% CI = 1.02–1.15). Moreover, tooth loss could increase NAFLD (OR = 1.33, 95% CI = 1.12– 1.56) and liver cancer risk (OR = 1.34, 95% CI = 1.04–1.74), and every five increment in tooth loss was associated with 5% increased liver cancer risk (OR = 1.05, 95% CI = 1.01 – 1.10) with a linear relationship. In addition, tooth loss had a positive tendency towards liver cirrhosis risk (OR = 2.03, 95% CI = 0.85–4.85) although there was no statistical significance. Conclusion: Periodontal disease and tooth loss are positively associated with liver diseases including NAFLD, elevated transaminase level, liver cirrhosis and liver cancer. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the presence and characteristics of spin (a distorted interpretation to make research findings seem favourable) in abstracts of randomized controlled trials (RCTs) in periodontology and oral implantology, and to explore its associated factors and influence on the subsequent literature. Materials and methods: PubMed was searched to identify recent RCTs in periodontology and oral implantology, whose primary outcome was non‐significant. Spin in abstracts was assessed and categorized according to pre‐determined spin strategies. The associations between study characteristics and the presence/severity of spin were analysed using multivariable logistic regressions. Results: 196 abstracts were included, 137 (69.9%) of which had spin. 57 (29.1%) abstracts had spin in the Results section, and 126 (64.3%) had spin in the Conclusion section. The main spin strategies in the Results and Conclusion sections were focusing on secondary outcomes (16.3%) and focusing on within‐group comparisons (28.6%), respectively. The presence of spin was associated with number of centres (OR = 0.28, 95% CI: 0.11–0.73; p =.009), while its severity was associated with topic (OR = 0.24, 95% CI: 0.08–0.70; p =.009). Conclusions: The frequency of spin is relatively high among published RCT abstracts in periodontology and oral implantology. Findings reported in these abstracts need to be interpreted with caution. [ABSTRACT FROM AUTHOR]

Aims: To systematically review the literature addressing the following focused questions: "What is the efficacy of either (#1) alternative or (#2) additional methods to professional mechanical plaque removal (PMPR) on progression of attachment loss during supportive periodontal therapy (SPT) in periodontitis patients?". Methods: A systematic search for randomized clinical trials was performed. Change in clinical attachment level (CAL) from baseline was the primary outcome. Results: Routine PMPR performed with either a combination of ultrasonic/hand instruments or Er:Yag laser showed similarly effective in preventing CAL loss. Moreover, a routine SPT regimen based on PMPR led to stability of CAL irrespective of a daily sub‐antimicrobial doxycycline dose (SDD). Finally, an adjunctive photodynamic therapy (PDT) did not enhance the magnitude of CAL gain when sites with probing depth ≥4 mm were repeatedly treated. After pooling all data, the results of the meta‐analysis showed no statistical differences in CAL change from baseline: mean overall CAL change was −0.233 mm (95% confidence interval: −1.065, 0.598; p =.351). Conclusions: Weak evidence indicate that in treated periodontitis patients enrolled in a 3–4 month SPT based on PMPR, Er:Yag laser (as alternative), SDD and PDT (as additional) do not produce a greater clinical effect on periodontal conditions compared to PMPR. [ABSTRACT FROM AUTHOR]

Aim: To answer the following PICOS questions: in patients with periodontitis, which is the efficacy of adjunctive systemic antimicrobials, in comparison with subgingival debridement plus a placebo, in terms of probing pocket depth (PPD) reduction, in randomized clinical trials with at least 6 months of follow‐up? Material and Methods: A systematic search was conducted: 34 articles (28 studies) were included. Data on clinical outcome variables changes were pooled and analysed using weighted mean differences (WMDs), 95% confidence intervals (CI) and prediction intervals (PIs), in case of significant heterogeneity. Results: For PPD, statistically significant benefits (p <.001) were observed in short‐term studies (WMD = 0.448, 95% CI [0.324; 0.573], PI [−0.10 to 0.99]) and long‐term studies (WMD = 0.485, 95% CI [0.322; 0.648], PI [−0.11 to 1.08]). Additionally, statistically significant benefits were also found for clinical attachment level, bleeding on probing, pocket closure and frequency of residual pockets. The best outcomes were observed for the combination of amoxicillin plus metronidazole, followed by metronidazole alone and azithromycin. Adverse events were more frequently reported in groups using systemic antimicrobials. Conclusions: The adjunctive use of systemic antimicrobials in periodontal therapy results in statistically significant benefits in clinical outcomes, with more frequent adverse events in test groups using systemic antimicrobials. [ABSTRACT FROM AUTHOR]

Aim: To assess the efficacy and adverse effects of resective surgery compared to access flap in patients with periodontitis. Methods: Randomized controlled trials with a follow‐up ≥6 months were identified in ten databases. Screening, data extraction, and quality assessment were conducted by two reviewers. The primary outcome was probing pocket depth, and the main secondary outcome was clinical attachment level. Data on adverse events were collected. Meta‐analysis was used to synthesize the findings of trials. Results: A total of 880 publications were identified. Fourteen publications from nine clinical trials met the inclusion criteria and were included for analysis. Meta‐analysis was carried out using all available results. The results indicated superior pocket depth reduction following resective surgery compared to access flap after 6–12 months of follow‐up (weighted mean difference 0.47 mm; confidence interval 0.7–0.24; p =.010). After 36–60 months of follow‐up, no differences were found between the two treatments in pocket depth and attachment level. The prevalence of adverse effects was not different between the groups. Post‐operative recession tended to be more severe for the resective approaches. Conclusion: Resective surgical approach was superior to access flap in reducing pocket depth 6–12 months post‐surgery, while no differences between the two modalities were found at 36–60 months of follow‐up. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the efficacy of subgingival instrumentation (PICOS‐1), sonic/ultrasonic/hand instruments (PICOS‐2) and different subgingival instrumentation delivery protocols (PICOS‐3) to treat periodontitis. Methods: Systematic electronic search (CENTRAL/MEDLINE/EMBASE/SCOPUS/LILACS) to March 2019 was conducted to identify randomized controlled trials (RCT) reporting on subgingival instrumentation. Duplicate screening and data extraction were performed to formulate evidence tables and meta‐analysis as appropriate. Results: As only one RCT addressed the efficacy of subgingival instrumentation compared with supragingival cleaning alone (PICOS‐1), baseline and final measures from 9 studies were considered. The weighted pocket depth (PD) reduction was 1.4 mm (95%CI: 1.0 1.7) at 6/8 months, and the proportion of pocket closure was estimated at 74% (95%CI: 64–85). Six RCTs compared hand and sonic/ultrasonic instruments for subgingival instrumentation (PICOS‐2). No significant differences were observed between groups by follow‐up time point or category of initial PD. Thirteen RCTs evaluated quadrant‐wise versus full‐mouth approaches (PICOS‐3). No significant differences were observed between groups irrespective of time‐points or initial PD. Five studies reported patient‐reported outcomes, reporting no differences between groups. Conclusions: Nonsurgical periodontal therapy by mechanical subgingival instrumentation is an efficacious means to achieve infection control in periodontitis patients irrespective of the type of instrument or mode of delivery. Prospero ID: CRD42019124887. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the efficacy of adjunctive therapies in reducing gingivitis and plaque by means of a systematic review of randomized clinical trials (RCTs). Material and Methods: A search protocol was designed to identify 6‐month RCTs that investigated the efficacy of adjuncts to mechanical plaque control on gingivitis and plaque. Following screening, relevant information was extracted, and quality and potential risk of bias were estimated. Mean treatment differences were calculated to obtain standardized mean differences and weighted mean differences (SMD and WMD) as appropriate. Results: Meta‐analyses included 70 studies of adjunctive antiseptics. Compared with mechanical plaque control alone, adjuncts yielded statistically significant reductions in gingival index (n = 72; SMD = −1.268; 95% CI [−1.489; −1.047]; p <.001; I2 = 96.2%), bleeding (%) (n = 26, WMD=−14.62%; 95% CI [−18.01%; −11.23%]; p <.001; I2 = 95.1%), plaque index (n = 93, SMD = −1.017; 95% CI [−1.194; −0.840]; p <.001; I2 = 95.3%) and plaque (%) (n = 23; WMD = −18.20%; 95% CI [−24.00%; −12.50%]; p <.001; I2 = 96.9%). Mouthrinses resulted in greater reductions in per cent plaque compared with dentifrices (meta‐regression, coefficient = 13.80%; 95% CI [2.40%; 25.10%]; p =.020). The antiseptic agents were similarly effective in reducing gingivitis and plaque in patients with dental plaque‐induced gingivitis (intact periodontium) or previously treated periodontitis with gingival inflammation. Conclusion: Adjunctive antiseptics in mouthrinses and dentifrices provide statistically significant reductions in gingival, bleeding and plaque indices. [ABSTRACT FROM AUTHOR]

Aim: Periodontitis has been identified as a moderate but independent risk factor for cardiovascular (CV) disease and progression. The objective of this study (ClinicalTrials.gov Identifier: NCT01045070) was to assess subgingival colonization with selected periodontal pathogens on the occurrence of further adverse CV events in a cohort of CV patients. Methods: The prevalence of severe periodontitis including the detection of 11 periodontal pathogens (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, Treponema denticola, P. intermdia, Peptostreptococcus micros, Fusobacterium nucleatum, Campylobacter rectus, Eubacterium nodatum, Eikenella corrodens, Capnocytophaga sputigena, Capnocytophaga gingivalis, Capnocytophaga ochracea; HAIN‐Diagnostica®) was analysed in 1,002 CV patients The prognostic impact of periodontal pathogens for combined CV endpoint (stroke/TIA, myocardial infarction, CV death, death from stroke) was evaluated after a 3‐year follow‐up period. Hazard ratios (HRs) were adjusted for established CV risk factors applying Cox regression. Results: In the Kaplan–Meier analysis (log‐rank test: p <.001) and Cox regression (HR: 0.545, 95%‐CI: 0.387–0.773; p =.001), the decreased occurrence of E. corrodens was shown to be an independent predictor for adverse CV events after 3 years of follow‐up. Conclusions: The detection of E. corrodens was associated with a reduced risk of adverse CV events in patients with CV disease. The pathophysiological background underlying this association should be investigated in further studies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between periodontitis and the incidence and mortality of gastrointestinal cancer. Method: A comprehensive literature search was conducted to identify all relevant studies published prior to April 2019 according to the established inclusion criteria. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated with a random‐effects model. Results: We identified 10 studies with 26 estimates of the relationship between periodontitis and gastrointestinal cancer. The HR for the incidence of gastrointestinal cancer in periodontitis was 1.23 (95% CI: 1.10–1.37). Subgroup analyses showed that periodontitis was associated with an increased risk of gastrointestinal cancers in prospective cohort studies and high–quality studies, North American individuals, and individuals 18 years or older, as well as when the dental status was self‐reported and when the study was adjusted for smoking. A meta‐analysis of nine reports demonstrated that periodontitis was associated with increased mortality from gastrointestinal cancer (HR = 1.59, 95% CI: 1.16–2.16). Additionally, periodontitis was associated with mortality from pancreatic cancer (HR = 2.20, 95% CI: 1.44–3.37); thus, periodontitis may be a risk factor for pancreatic cancer. Conclusion: Our meta‐analysis demonstrated that periodontitis may be a risk factor for gastrointestinal cancers. Additional prospective cohort studies are warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

Aim: A range of predictors for tooth loss in periodontitis patients have been reported. We performed a systematic review and meta‐analysis to assess the consistency and magnitude of any association between a total of 12 predictors and tooth loss. Materials and Methods: Medline/Embase/Central were searched for longitudinal studies investigating the association between predictors and tooth loss in periodontitis patients. Random‐effects meta‐analysis was performed, and study quality assessed. Results: Twenty studies (15,422 patients, mean follow‐up: 12 years) were included. The mean annual tooth loss/patient was 0.12 (min./max: 0.01/0.36). Older patients (n = 8 studies; OR: 1.05, 95% CI: 1.03–1.08/year), non‐compliant ones (n = 11; 1.51, 1.06–2.16), diabetics (n = 7; 1.80, 1.26–2.57), those with IL‐1‐polymorphism (n = 3; 1.80; 1.29–2.52) and smokers (n = 15; 1.98, 1.58–2.48) had a significantly higher risk of tooth loss. Teeth with bone loss (n = 3; 1.04, 1.03–1.05/%), high probing pocket depth (n = 6; 3.19, 1.70–5.98), mobility (n = 4; 3.71, 1.65–8.38) and molars (n = 4; 4.22, 2.12–8.39), especially with furcation involvement (n = 5; 2.68, 1.75–4.08) also showed higher risks. Gender (n = 16; 0.95, 0.86–1.05) and endodontic affection (n = 3; 3.62, 0.99–13.2) were not significantly associated with tooth loss. Conclusions: Older, non‐compliant, smoking or diabetic patients, and teeth with bone loss, high probing pocket depth, mobility, or molars, especially with furcation involvement showed higher risks of tooth loss. [ABSTRACT FROM AUTHOR]

Aim: To compare immediate implant placement (IIP) to delayed single implant placement (DIP, ≥3 months post‐extraction) in terms of implant survival (primary outcome), surgical, clinical, aesthetic, radiographic and patient‐reported outcomes (secondary outcomes). Materials and Methods: Two reviewers independently performed an electronic search in PubMed, Web of Science, EMBASE and Cochrane and a hand search to identify eligible studies up to May 2018. Only randomized controlled trials (RCTs) and non‐randomized controlled studies (NRSs) comparing IIP to DIP with at least 1 year of follow‐up were selected for a qualitative analysis and meta‐analysis. Results: The search identified 3 RCTs and 5 NRSs out of 2,589 titles providing data on 473 single implants (IIP: 233, DIP: 240) that had been in function between 12 and 96 months. One RCT showed unclear risk of bias, whereas all other studies demonstrated high risk. Meta‐analysis showed significantly lower implant survival for IIP (94.9%) as compared to DIP (98.9%) (RR 0.96, 95% CI [0.93; 0.99], p = 0.02). All were early implant failures. A subgroup meta‐analysis demonstrated a trend towards lower implant survival for IIP when postoperative antibiotics had not been administered (RR: 0.93, 95% CI [0.86; 1.00], p = 0.07). This was not observed among studies including the administration of postoperative antibiotics (RR: 0.98, 95% CI [0.94; 1.02], p = 0.35). Meta‐analyses showed similar probing depth (WMD 0.43 mm, 95% CI [−0.47; 1.33], p = 0.35) and aesthetic outcomes as assessed by the pink aesthetic score (standardized WMD −0.03, 95% CI [−0.46; 0.39], p = 0.88) for IIP and DIP. Data on marginal bone loss were conflicting and highly biased. Soft tissue recession was underreported and available data were highly biased. Patient‐reported outcomes were underreported, yet both IIP and DIP seemed well tolerated. Conclusion: Immediate implant placement demonstrated higher risk for early implant loss than DIP. There is a need for RCTs comparing IIP to DIP with CBCT analyses at different time points and data on midfacial recession with the preoperative status as baseline. In these studies, the need for hard and soft tissue grafting should also be evaluated. [ABSTRACT FROM AUTHOR]

Aim: To assess the long‐term effectiveness (≥5 years) of maxillary sinus floor augmentation (MSFA) procedures applying the lateral window technique and to determine possible differences in outcome between simultaneous and delayed implant placement, partially and fully edentulous patients and grafting procedures. Materials and methods: MEDLINE (1950–May 2018), EMBASE (1966–May 2018) and Cochrane Central Register of Controlled Trials (1800–May 2018) were searched. Inclusion criteria were prospective studies with follow‐up ≥5 years and a residual bone height ≤6 mm. Outcome measures included implant loss, peri‐implant bone level change, suprastructure survival, patient‐reported outcome measures and overall complications. Data were pooled and analysed using a random effects model. Results: Out of 2,873 selected articles, 11 studies fulfilled all inclusion criteria. Meta‐analysis revealed a weighted annual implant loss of 0.43% (95% CI: 0.37%–0.49%). Meta‐regression analysis did not reveal significant differences in implant loss neither between edentulous and dentate patients nor implants placed simultaneously with or delayed after MSFA, nor implants placed in MSFA using solely autologous bone or bone substitutes. The results of the other outcome measures were favourable, and overall complications were low. Conclusion: MSFA is a reliable procedure in the partially and fully edentulous maxilla for support of dental implants. [ABSTRACT FROM AUTHOR]

Aim: The aim of the current systematic review was to critically appraise evidence from randomized and prospective non‐randomized comparative clinical trials about the efficacy of lateral bone augmentation prior to implant placement and their outcome regarding bone width gain. Materials and Methods: Eight databases were searched until May 2018 for randomized and prospective non‐randomized comparative trials on lateral bone augmentation prior to implant placement. After elimination of duplicate studies, data extraction and risk‐of‐bias assessment according to the Cochrane guidelines, random‐effects meta‐analyses of mean differences (MD) or relative risks (RR) and their 95% CIs were performed, followed by subgroup, meta‐regression and sensitivity analyses. Results: Overall, 25 trials (16 randomized/9 non‐randomized) were identified, which included a total of 553 patients (42.2% male; mean age of 43.9 years). In these included studies and populations, various modalities for primary lateral bone augmentation rendered implant placement feasible. Small discrepancies were found between overall clinical and radiographic gain (pooled gains of 3.45 ± 1.18 mm versus 2.90 ± 0.83 mm, respectively), but were not statistically significant. Bone width gain was significantly inversely associated with baseline bone width (pooled effect: −0.35 mm/mm; 95% CI: −0.63 to −0.07 mm; p = 0.01). Additionally, % graft resorption was associated with patient age (36%/year, 95% CI: −0.62 to −0.11 mm; p = 0.01). The presence of xenograft added to autologous graft led to less resorption compared to autologous graft alone (MD: 1.06 mm; 95% CI: 0.21 to 1.92 mm; p = 0.01). Barrier membrane did not yield significant difference in terms of bone width gain (MD: −0.33 mm; 95% CI: −2.24 to 1.58 mm; p > 0.05) and graft resorption (MD: 0.84 mm; 95% CI: −1.42 to 3.09 mm; p > 0.05). However, the quality of evidence ranged from very low to moderate due to bias and imprecision. Conclusions: Initially smaller bone dimensions are associated with favours larger bone width gain, which indicates that a severe lateral bone deficiency can be effectively augmented applying primary lateral bone augmentation. Both Patients' age and recipient site (maxilla or mandible) seem to influence graft resorption. The addition of a xenograft can be helpful in reducing graft resorption. Existing evidence from randomized and prospective non‐randomized trials on humans indicates that lateral bone augmentation prior to implant placement can successfully increase bone width. There are some indications that patient‐related, site‐related, and technique‐related characteristics might influence the amount of gained bone width, but the quality of evidence is for the most part hampered by the small number of existing studies and methodological limitations that might lead to bias. [ABSTRACT FROM AUTHOR]